Here is a great new book to cheer libertarians as we draw close to the sixtieth anniversary of the National Health Service. Written by the director of Nurses for Reform, Dr. Helen Evans, and published by the Institute of Economic Affairs, ‘Sixty Years On: Who Cares for the NHS?’ not only shows that the country’s top 100 health opinion formers no longer actually believe in nationalised healthcare but, gloriously, this book fundamentally challenges the medical monopoly inherent in all health systems around the world.
Citing a huge array of free marketeers the work is awash with glorious quotes like this one from David Friedman:
Both barbers and physicians are licensed; both professions have for decades used licensing to keep their numbers down and their salaries up. Government regulation of barbers makes haircuts more expensive; one result, presumably, is that we have fewer haircuts and longer hair. Government regulation of physicians makes medical care more expensive; one result, presumably, is that we have less medical care and shorter lives. Given the choice of deregulating one profession or the other, I would choose the physicians.
Quoting our own Brian Micklethwait we again read:
Far from being obvious to me that a truly free medical market would be disastrous, I believe on the contrary that such arrangements would be of huge benefit to mankind, and that the sooner medicine is done this way the better.
Things would not, inevitably, be perfect. Some fools would make crass blunders, by ignoring manifestly superior medical services for the most frivolous of reasons, and by patronising the most notoriously incompetent. Some such fools would perish from their foolishness. Others would merely be unlucky. No law can prevent either stupidity or bad luck, although the world is now filled with the particular stupidity which consists of refusing to face this truth, and with the many luckless victims of this stupidity.
Powerfully, he concludes:
Given that for most people the avoidance of suicide rather than suicide is the objective, a truly free medical market would enable them, for the first time ever, to purchase steadily improving medical advice and medical help, and at a steadily diminishing price.
One of the most pernicious restrictions on medicine imposed by the current medical regime is the restriction on advertising. In a free market rival medical procedures, rival medical ‘philosophies’, rival views on the relative importance of confidentiality, hygiene, speed of treatment, riskiness of treatment, and so forth, would all battle it out in the market place. ‘Alternative’ therapists would be allowed to prescribe potentially dangerous drugs, as only government favoured therapists may now. It would be up to the patients to pick therapists who seemed to know what they were doing and their look out if they chose badly. The already thriving medical periodical press would assist with voluminous comparative advice, praise and criticism.
In such a free market, any number of different medical styles could be practised, and patients would make their choices.
Evans’s book is a must read for libertarians. It is also a tonic for the period of NHS propaganda we will no doubt endure over the next couple of weeks.
As a practicing doctor, I would welcome deregulation. All of my objections to this broadly fall into the ‘what about the children?’ basket. However, I feel that complete deregulation will not occur, for the same reasons that prevent weaning from the welfare nipple.
I am quite happy to provide a product, backed by evidence, that will lower the risk of developing disease, diagnose disease, and treat disease. I will back my products and services against allcomers, who mainly deal in wellness.
A voucher system (like Medicare in Australia), allowing the patient/client to pick a provider, would seem to me to be the best replacement for the NHS, together with the threat of legal action for those whose results do not match their claims.
Let the market decide.
Whenever I discuss universal healthcare in the US I always bring up the Medicare/Medicaid example. We already have universal healthcare for those who can’t afford it in the US, and I pay 2.9% of my paycheck every week for it.
How’s it working out? Not so well. In fact, it is so bankrupt that it makes our ridiculous Social Security retirement system look downright solvent.
And yet somehow some people think MORE of this will somehow “solve the problem” whatever that may be.
Kudos to the nurses. I hope more people would listen to them.
The original work on the specifics of how doctor licensing was a fraud was done by Milton Friendman.
It would be sensible to cite it.
What sources of information would people use about deregulated medics? What I mean is, how would people know the info about Dr A’s amazing success in treating cancer wasn’t, basically, a load of crap? How could we be informed health consumers?
Valdemar, informational associations would spring up to “vet” claims by medical practitioners, sort of like Underwriters Laboratories. The medical associations, if they wished to remain relevant, might even start to provide relative rankings of their members (and some people would assign those rankings much weight). We haven’t had independent sources for assessing medical quality because of the government-imposed monopoly on health services. If all practitioners were to compete openly, a niche would open up for independent reviewers (who themselves would compete for the best reputations and quality of information). People like you have become so brainwashed that you think that only the government can adequately assess medical quality. In reality, it does a lousy job of this (for example, look at the quality of the FDA). If permitted to do so, the market would take care of this.
Incidentally, I have the same problem with the monopoly of legal services. It should be deregulated, too.
Fraud King Kevin Trudeau has sold more than 5 million copies of Natural Cures “They” Don’t Want You to Know About. The book contains not one cure for any disease. Anyone could have plugged his name into Google and read about the shyster he is. And this is easy, untechnical, this-guy-is-full-of-shit reading. Try reading the NEJM or The Lancet sometime.
A free market in medicine is going to need a whole lot of fraud enforcement. Trudeau himself ought to be in jail.
Trudeau quacks like a duck. Nevertheless, people made the free choice to buy his products and follow his edicts and doubtless, eventually, they or their surviving relatives will freely take him to court. Those who would use a voucher system (private or public) to purchase Trudeau ‘medicine’ would expedite this process as the voucher providers sought to limit their liability to the resulting mess by excluding Trudeau products.
Laird,
How will I know which rating organizations I should trust? I already know that organizations such as ‘Which’ get verdicts wrong (e.g. on digital cameras and computers), and that’s for physical equipment that can be measured objectively. How much less reliable will they get when it’s not possible to measure how ill a person was before or after treatment, or what percentage of the maximum possible improvement a physician caused?
I’m a smart, well-educated consumer, and I’m not sure of my ability to decide on the best treatment. I know, for example, that a recent study looking at how people felt about the treatment they received bore no relation to the quality of care actually provided. So I can’t trust my own impressions, even if (perhaps explicitily because) they feel real to me, and I can’t trust anyone else’s impressions either. And I’m one of the informed consumers.
On the upside that doesn’t really put me any worse off than now – I don’t expect the NHS can tell any better than UL who is competent or not.
Paul, you have just answered your own question. It is not going to be perfect, but it certainly is not going to be any worse than it is now, and quite possibly much better.
You should be. There is no person that knows what is good for you better than you do. This doesn’t mean that you don’t need to gather as much relevant information as you possibly can, including consulting the best professionals. A private system can give you a much better access to those. But the final decision is yours, just as it is under the current system (or at least it is supposed to be).
Insurance. Take a good look at the medical service provider’s insurance policy and see what it covers them for. Also look for public evaluation lists similar to the feedback on auction sites like eBay, but of course they will be much more detailed. Also look for a medical service provider who guarantees that all settlements with dissatisfied patients are public record, no secret settlements. I would reject any provider who refuses to release the full and accurate details of their litigation history including the full details of dropped claims and settled out of court claims.
Top quality, honest and capable medical service providers will be virtually throwing this kind of information at you. Any body who doesn’t want this information and feedback on open public record shouldn’t be trusted.
Alisa,
The idea that there is nobody better able to decide what is good for me than me, at least in medical decisions, is ludicrous. I’m pretty good at collecting and organizing data and opinions, but unless those opinions are about me specifically then they’re only general guidance. And if the opinions *are* about me I have no real grounds to judge them; if one doctor says “yes” and another “no”, I can’t tell who is right, or even if there is a right. While retaining a cautious skepticism I’ll listen to what a doctor tells me I need more than I will what ‘feels’ right, or what the internet says.
And what do you do when one doctor tells you ‘yes’, and the other ‘no’? And how is this situation different in either regulated or unregulated system?
Ultimately I guess – I listen carefully to their comments, think through what I’ve read, try to remember that the choice I want to be right isn’t necessarily the right one, and the I guess. Under the current system it’s somewhat the same, but we’re more likely to let the trained medical professional guess for us.
For me it probably is no worse than the current system, but I’m among the more educated health users; for the average person paternalism, as undesirable as I count it in generally, may actually be the less worse solution. And that’s before we get to those people whose problem specifically prevents them from making a decision; a relative is currently in treatment for brain cancer, and on most days he can struggle to make the wisest choice about breakfast.
I’d like to apologize for my use of the word ludicrous, btw; I was commenting carelessly, and I’m pleased that you rose above my level to reply.
Paul, I understand that there will always be people who are unwilling or unable to make their own decisions. But if there is demand for such a service (i.e. “decision making”, in medicine, as well as in any other area), why wouldn’t private sector be able to meet such demand?
I am not a native English speaker, so I wasn’t aware that ‘ludicrous’ is supposed to be that offensive:-)
I am a power of attorney for healthcare and a durable health care power of attorney for someone who is mentally incapable of making their own choices and I had the same role for someone else during their last years of life. It is no different than making choices for one’s self except that you make them in the context of the other person’s general values and desires to the best of your ability.
I have also had significant medical care myself as an insured person and have attempted to purchase it for cash when I did not have insurance.
Paul, in all cases, it is dangerous to trust the present medical industry. It responds only to the institutionalized incentives. Regrettably, good care and medical accountability are not incentivized. Playing the various government and private ‘insurance’* plans for the maximum pay-out that they can (short of criminal fraud in most cases) is their only incentive. ‘Insurance’* companies in turn have accountants making the medical care decisions they are completely unqualified to review. The level of misconduct necessary to gain censure is impressive and not generally related to their actual medical decision making skills. My sisters and two of my nieces are registered nurses and whenever family members in their proximity need medical care they go straight to the nurse’s grape vine. The medical care available in the US ranges from incredibly good to incredibly bad. But the present system makes it almost impossible for the layman to discern who provides what.
A free and open market can only help everybody that doesn’t have an inside connection to find out where the good care is to be found. I think you have your worries reversed.
* ‘Insurance’, whether NHS, Medicare or company plan, is almost never truly insurance but rather a medical services payment program with substantial redistribution from healthy people to unhealthy ones. I think any ‘insurance’ plan that pays out more often than every few years (like car and home insurance does) is not insurance at all. This means that the only medical insurance that really is is catastrophic major medical with a several thousand dollar deductible.
Alisa – I don’t think the private sector can’t do these things, I’m saying that few people are equipped to judge how they do it. People are too often sucked in by deals that look good but don’t ultimately deliver. If that gets them a crappy TV or an unreliable car, well bad luck, maybe they’ll be more careful next time. If, on the other hand, they get sucked in by something like ‘chelation therapy’ and become physically/mentally damaged or even die, well good luck to them learning from that mistake.
So my complaint is about intent. The people who work in the NHS are by and large concerned with helping people. Too many are concerned with hitting targets, or going home on time, or on feeling powerful, for sure. But the basic intent is good. In contrast private care is concerned with making money, and so long as you can appear to be successful enough to get more custom you’ve done your job. That’s fine for a florist or a garage, but not when you’re in charge of people’s lives.
Having said that I’m all for people treating the NHS as a safety net, and branching out into whatever private area of treatment they want. I don’t want to stop them making a mistake, I just want someone who isn’t trying to profit from their condition to warn them in advance.
Oh, and ludicrous isn’t offensive, just far more intemperate than I normally aim for. And please accept my compliments on your English!
Midwesterner – your suspicion of the current medical establishment is well founded. I’ve no doubt that they’re not all angels in white hats who only have our best interests at heart and all medical knowledge in their hands. But to claim that the market can only improve this situation seems, to me, demonstrably false. It’s the market that promotes ideas such as the aforementioned chelation therapy, or homeopathy. These aren’t silly little hobbies, these are bogus treatments that cost people their lives. And that’s when we have essentially honest doctors telling us just that. I dread to think how much worse things would get if there was nobody I could turn to who I knew wasn’t concerned first about covering payroll and office space.
Actually, when accurate information is unavailable as it is now with mainstream medicine, people who haven’t read a bunch of drug research as I have don’t know what to believe. The misplaced faith in the things you name is precisely because of the lost faith in business as usual. I don’t want to get into too many details of the health care histories of the persons who have trusted me with their information and decisions, but I can tell you that it is far easier to detect the kind of frauds you name than the ones in the breathtakingly lucrative prescription drug field.
If you have a chance to read research papers cited in drug approvals, I encourage you to completely ignore the summary until you have read the entire body of the research. I did this a few times by coincidence rather than by plan and something jumped out at me. When you get the to the summary, which is the only part most people ever see, the writing style and the entire tenor of the paper changes. It took me a while to realize that the summaries were in many cases being ghost written by marketing professionals presumably supplied by the company(s) that funded the research.
I also noticed something else. All research is favorable for the drugs. Unfavorable research is almost never published and is, I suspect, usually never finished. If it won’t sell product, I guess they pull the plug.
I began researching prescriptions too late. My father died of the side effects of a ‘totally safe’ drug, omeprazole, that he was taking for a hiatal hernia. What nobody every mentioned was that it extremely effects calcium absorption and causes osteoporosis and major fractures. He didn’t have a hip fracture, he had multiple spinal fractures and died after about a year of great pain and immobility. He had been taking calcium but the omeprazole was preventing it from reaching his system. He was on the drug for several years and the effects tend to be cumulative. All the manufacturers would have needed to do is give omeprazole a ‘black box’ warning for users to be regularly tested for bone density and an awful lot of people’s misery could have been prevented.
Mid, thanks for the tip. I sent it to my husband, he has been taking Prilosec on a regular basis.
Paul, doctors who work for the bottom line are doing so under the current system as well. Those who do it to help people will do so regardless of where the profit comes from.
Midwesterner – I agree totally that drug licensing is imperfect, and the way that drug companies manipulate is grossly immoral. But as poor as it is now, I can see no reason why inserting another level of people I have no reasonable means of differentiating between would make it better. NICE in the UK do the job, not all that well, but I know what there motives are, and they aren’t to make money.
Alisa – I alo agree with you 🙂 that doctors are trying to make a profit. But the prospects for doing this are limited by the current system; people in the UK become doctors to do quite nicely, not to become rich. Undoubtedly that discourages a few who would be excellent, profit-motivated doctors. I suspect, however, it deters far more who would be excellently profit-motivated, but not much in the way of doctors (or even worse, charlatans).
On what do you base this suspicion?
Because we don’t have a way of measuring the success of doctors with any great accuracy (certainly not with crude measures like survivability). Without that we’re dependent on the motivation of the doctor. Personally I’d rather take a doctor who derives satisfaction from helping people, as opposed to one who needs to make it look like he helped me enough to attract further custom.